原位心脏移植心内膜活检组织的电镜观察及排异监测

Electron Microscopic Observation of Endomyocardial Biopsy for Monitoring of Acute Rejection of the Orthotopic Transplanted Heart

心脏移植在我国起步较晚，近年只有少数几家医院实施了这种手术，但术后长期存活病人不多，其中多死于排异反应。同种异体心脏移植早期，急性排异较为多见，是移植器官不能长期存活的主要原因之一。因此，应用多种方法检测供体功能，监测排异反应发生极为重要，其中以心内膜心肌组织活检（ＥｎｄｏｍｙｏｃａｒｄｉａｌＢｉｏｐｓｙ，ＥＭＢ）光镜观察较为简便、直观，已成为心脏移植免疫监测的常规方法。本文对１例原位心脏移植病人供心内膜活检组织连续６次进行电镜观察，在细胞超微结构水平，根据免疫细胞类型，心肌细胞及血管病变，对急性排异反应发生强度、免疫抑制药物治疗效果。

In China heart transplantation has just begun,only a few operations were done recently.Acute rejection is the most common cause of early death of this operation.Postoperative endomyocardial biopsy(EMB) is still the most valuable method for monitoring the transplanted heart function and final diagnostic confirmatin of acute rejection and the morphological changes also provides the guide of immunosuppressive drug therapy.Six consecutive EMB were obtained from a case of orthotopic transplanted heart,morphological observation was performed according to immune cell typing and myocardial ultrastructural changes,occurrence of acute rejection was definite.The pathological changes were rveversed after immunosuppressive drugs treatment.We believe that EMB provides the most reliable method of monitoring for an acute cardiac rejection activity in donor heart by electron microscopy.